Risks of delaying a sight test

This guide describes the risks to patients that result from delaying a sight test.

As well as an eye health check, a sight test can detect signs of underlying general health conditions, such as diabetes, high cholesterol, and high blood pressure. It is especially important in early identification of leading causes of preventable blindness such as glaucoma and diabetic retinopathy. Everyone should have a sight test every two years or more often if an optometrist recommends it.

Glaucoma
Glaucoma affects 1-2% of the population, and is a leading cause of sight loss. In the majority of cases, glaucoma is asymptomatic, so regular sight tests are important for detecting glaucoma. The majority of patients with glaucoma are diagnosed following referral from an optometrist. Without regular sight tests, the prevalence of late presentation, sight threatening glaucoma, would rise.

Diabetic retinopathy
People with diabetes are at a high risk of developing complications leading to retinopathy and possible blindness if untreated. There is a national eye screening programme in place within the UK to detect signs of retinopathy. Almost 20% of people fail to access this each year and this figure is higher in some of the most deprived areasⁱ. Attending regular sight tests allows signs of developing retinopathy to be identified.

Risks for older people
The Royal National Institute of Blind People (RNIB) has reported that 72% of older people delay their sight test because they don’t believe they have any eye or vision problemsⁱⁱ. The risks of severe complications caused by delaying a sight test are especially acute for the poor and the elderly.

Risk of falls
Uncorrected vision in older people also increases the risk of falls. Falls are the leading cause of disability and death from injury among people over 75 in the UKⁱⁱⁱ.

Disadvantaged groups
Men are more likely to present with late stage glaucoma than women^iv. This is also true for those from an African Caribbean background. Late presentation leads to a greater risk of complications including blindness.

Research in other countries also indicates that the most socio-economically disadvantaged groups have poorer outcomes with greater likelihood of severe vision impairment^v.

Significant barriers to receiving timely eye care are deprivation and people’s assumption that sight tests are for people who already have vision problems^vi. However, some of the most sight-threatening conditions are asymptomatic. Whilst the number of NHS sight tests has risen by around 2% each year for the past decade, there is still an unmet need due to a rising population with a greater proportion of elderly people.

The poor and frail/ elderly can both suffer from undiagnosed and often treatable vision impairment. Up to half of this group have undiagnosed cataracts, macular degeneration or uncorrected refractive errors^vii.

It is estimated that one in ten of the learning disability population in England is blind or partially sighted. Children with learning disabilities are 28 times more likely to have a serious sight issue than other children. People with learning disabilities are also much less likely to access a sight test. Research shows that 50% of adults with learning disabilities had not had a sight test in the recommended period, and four in ten children in special schools have never had a sight test.

Risks for children
There is national guidance recommending vision screening for children in the UK at the ages of 4-5. However, freedom of information requests conducted by the Clinical Council for Eye Care Commissioning (CCEHC) have revealed that provision is patchy with some areas providing no screening at all ^ix. Even where screening does happen, as it is carried out only on four-five year olds, it is not suited to identifying long sightedness (hyperopia) or astigmatism^x. Children may not realise when their vision is poor and are less likely to mention visual problems.

Undetected conditions such as amblyopia (lazy eye) have been shown to adversely affect reading ability and therefore may impact on future educational attainment^xi. Hyperopia, or long sightedness, has also been linked to poorer literacy in young children^xii. Spotting vision problems through regular sight tests is critical to a child’s future health and education.

Driving risks
There is no requirement in the UK to have a sight test to obtain a driving licence.

Undiagnosed vision problems amongst drivers can increase the risk of accidents, particularly those that affect distance and side vision.

In 2012, an estimated 2048 drivers were involved in accidents due to poor vision; leading to 2874 casualties^xiii. This is likely to increase as the population ages. 

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ⁱ NHS Screening programme: KPI reports (2014-15) www.gov.uk/government/publications/nhs-screening-programmes-kpi-reports-2014-to-2015

ⁱⁱ RNIB (2007) Older people and sight tests. Don’t let age rob you of your sight. www.rnib.org.uk/sites/default/files/Older people and eye tests Campaign report_0.pdf

ⁱⁱⁱ College of Optometrists, endorsed by Royal College of GPs & Age UK (2011) The importance of vision in preventing falls. www.bgs.org.uk/pdf_cms/reference/vision-in-falls.pdf

^iv Fraser S, et al. (1999) Retrospective analysis of risk factors for late presentation of chronic glaucoma. British Journal of Ophthalmology. 83.1: 24-28.

^v Munoz B, et al. (2000) Causes of blindness and visual impairment in a population of older Americans: The Salisbury Eye Evaluation Study. Archives of Ophthalmology 118.6: 819-825

^vi Jessa Z & Evans B (2009) Improving the detection of correctable low vision in older people, City University

^vii Cox A, et al. (2005) Visual impairment in elderly patients with hip fracture: causes and associations. Eye 19.6: 652-656

^viii SeeAbility (2016) Delivering an equal right to sight. www.seeability.org/equalrighttosight

^ix Clinical Council for Eye Health Commissioning (2016) Freedom of information request to 151 local authorities regarding vision screening for children at age four and five 

^x O'Donoghue L, et al. (2012) Visual acuity measures do not reliably detect childhood refractive error-an epidemiological study." PLoS ONE 7.3 : e34441.

^xi Stifter E, et al. (2005) Monocular and binocular reading performance in children with microstrabismic amblyopia. British Journal of Ophthalmology 89.10 : 1324-1329

^xii Kulp MT, Ciner E, Maguire M et al. (2016) The VIP-HIP Study Group.  Uncorrected Hyperopia and Preschool early literacy: Results of the Vision in Preschoolers-Hyperopia in Preschoolers (VIP-HIP) Study. Ophthalmology  123(4): 681-9

^xiii RSA Insurance Group (2012) Fit to Drive: a cost benefit analysis of more frequent eyesight testing for UK drivers.www.roadsafetyobservatory.com/Evidence/Details/10808